Encopresis (Holding on to Poop)

Parent Q&A

My daughter is 3 and over the last several months she has become quite hysterical while pooping. We think it started with a bout of constipation a while back and we gave her Miralax. We started giving her Miralax every day when we realized that this was a constant problem. We were told that she'd calm down once she forgot that it ever was painful for her. But we have had her on daily Miralax for over 6 months and she is not better, she is actually worse than she used to be. She withholds her stool which of course doesnt' help. We have had her evaluated by her pediatrician as well as a pediatric GI and they don't think anything is wrong. The GI suggested we start putting her on the potty to poop to finish up our potty training and although she is allowing us to do this, reluctantly, this doesn't seem to change the pain of it for her. In the last week she has gotten poops in to the potty but not without a lot of screaming and crying both before it comes out and during. Even if she poops in a diaper, she screams and cries just as much. The poop that comes out is extremely soft so I don't know how it could be painful but she screams that it hurts all throughout the process. Sometimes it takes as long as an hour or more. We explored the possibility of sensory processing disorder but the few occupational therapists I've talked to don't think she has that even though she seems hypersensitive to the feeling of needing to poop and the feeling of it coming out. She has a few other symptoms of SPD including extreme sensitivity to cutting her toenails, and doesn't like to have her hair washed in the bath. But our main problem is the pooping. We are wondering if the Miralax could be making her poop acidic which is painful for her as it comes out? But I'm afraid to stop the Miralax because every time we let up on it a little bit, her poop is harder and she freaks out even more. One thing we are not totally sure about is whether this is actual pain or is it anxiety about possible pain? We have started her in play therapy but we are desperate for things that could help her. The daily struggle of going through this with her is taking a major toll on us and we are desperate for anything else that we could try. If any of you have suggestions, or have gone through this with your children, we'd appreciate any tips. I know sometimes autistic kids have trouble with pooping, and we'd love suggestions that have worked for them too as it might be something we could try with her. Thank you for any help or encouragement you could provide!

miralax has polyethelyne glycol, a petroleum based product... found in anti freeze... the fda has done no studies for long term use of miralax... but i would not give this to my child... I think flax meal works great with alot of water and pure concord grape juice... you can sprinkle flax meal on everything...

for the emotional part, we used jin shin jyutsu, an energy healing and it worked very well.... for small kids you only need a 10 minute session or so....

I'm so sorry to hear you're all going through this. If you're feeling up to it, I would try offering flax seed meal in some baked goods (you can use it as an egg replacer in baked goods-- google the ratio on minimalist baker-- it's great!) or try mixing a little bit into some orange juice just to alternate between miralax if you're suspecting taking that is affecting her stool. You may have already checked in with her pediatrician, but checking to see about any food allergies might be helpful-- it took me 18 years to get diagnosed as Celiac (this was a long time ago!) but the pain she's experiencing sounds familiar.

I wanted to respond because we lived through the same thing - 10 years ago! My son is a teen now and it's long behind us, but it was truly one of the hardest periods for us. Please google encopresis and start learning about it; doctors aren't very knowledgeable about this issue. My son suffered from encopresis from age 3-5. We tried EVERYTHING in different combinations:homeopathy, miralax, probiotics, magnesium supplements, fiber supplements, diet vigilance, reward charts, little presents, shouting (I don't like to admit that one, but it is so frustrating at times), and saw Meg Zwieback. None of that really worked. What did work? The Soiling Solutions protocol (https://www.encopresis.com/). It absolutely changed our entire family's life. The manual costs $75 online and I was very reluctant, since it sounded weird/quackish etc, but this program was the only thing that worked. (I'd give you the manual but I already gave it to someone else on BPN.) Anyway, the program is tough in the beginning and we didn't get results for the first 2 months, because my son was five before we tried it, but it works. I'm sorry you're going through this. Many kids have this issue, but no one talks about it, so you feel totally alone! And most pediatricians recommend Miralax but that's not the answer to this complex physical/emotional/behavioral problem. For several years after finishing the program, my son kept drinking a product called Juice + Fiber, because that was critical to continued success. The insoluble fiber in that is key - and discussed in the Soiling Solutions protocol - and it's the same as acacia fiber (Heather's Tummy Fiber), so you can just buy that and mix into smoothies instead. It gets better, I promise! Good luck!

We are in search of any advice from folks who have successfully dealt with their child's encopresis. anonymous

My son suffered from encopresis for several years and I know what you're going through. We tried EVERYTHING in different combinations: homeopathy, miralax, probiotics, magnesium supplements, fiber supplements, Juice Plus Fiber, diet vigilance, reward charts, little presents, shouting (I don't like to admit that one, but it is so frustrating at times), and even saw Meg Zwieback paying out of pocket. None of that really worked to cure the problem. Well, I will save you the time and money and tell you about Soiling Solutions (http://www.soilingsolutions.com/). It was the best thing that ever happened to us, it absolutely changed our entire family's life. It costs $75 online and I was super reluctant, thought the whole thing sounded weird/quackish etc., and even tried to back out of doing the program. But this program is a miracle. It's tough in the beginning and we didn't get results for the first 2 months, but it works. I would be happy to talk to you more about it via email (curanto [at] yahoo.com), and we even have the manual that I'd be happy to lend you. We don't need it anymore -- our son is fully cured for the last two years. He is a different kid. Sorry you're going through this, and the pediatricians really don't know anything about how to help: they just push Miralax and that is not the answer to this complex physical/emotional problem. Been there

We are still working on encopresis at our house. The new bit of help that we got was that the g.i. specialist ordered an x- ray for our son. The x-ray showed that he is constipated although his stool comes out soft and he goes all the time. Now he's supposed to get Miralax daily for 6 months. He and I are feeling more hopeful. Good luck! Dealing with the same problem

My 19 month old daughter becomes extremely anxious and panic stricken at the idea of having a bowel movement. This started after she contracted a virus that caused severe and frequent diarrhea. Now she does she all can to avoid pooping. I'm afraid this could lead to bowel obstructions and other problems. Has anyone ever had experience with this? Bummed about her BMs

When my daughter was 18 mos., she developed a similar fear of having BM's (in her case, it was because of 2 painful hard poops). Unforunately, it developed into a 2+ year problem. My advice is to take it VERY seriously now, before it becomes an ingrained habit. I think the best advice is to keep your child as regular as possible, and to this end she'll need lots of water, fiber, dried fruits, etc. However, if this doesn't work--it didn't with my child, whose ability to hold in her poops was nothing short of herculean--MIRALAX is the way to go. This is a prescription laxative that is apparently more gentle than Senica (sp?) or the other over-the-counter meds. We gave it to our child daily (at our ped's recommended dose), just to keep th! ings flowing. When she didn't go for a few days, we increased the dose. The key is to keep things regular, and not painful, so that her associations with pooping=pain are replaced with pooping=no big deal. I wish you well, and hope your problem doesn't become as bad as ours did.
Christine

My son is almost two years old, and for the past 7 months or so, he has been withholding his bowel movements. It seems as if we have tried everything possible to remedy this problem: his diet consists of strictly whole grain and/or high fiber foods, his consumption of dairy products is very minimal (I am still breastfeeding). We have tried flaxseed meal and flaxseed oil, he has had to endure several enemas and suppositories. Following a recent three-week period of withholding his bowel movement, our doctor prescribed MiraLax. It really works well, but I just hate the idea of my otherwise healthy child taking daily medication. I heard that frequently children stay on this medication for months or even years. I feel horrible every time I add it to his morning oatmeal. But I simply don't know what else to do. Any suggestions?! Our doctor has assured us that MiraLax is quite safe. Has anyone heard otherwise? desperately seeking advice

I can totally relate to your fears and the difficult situation you face. Our Dr. tried to prescribe MiraLax over a year ago when my son was 3. We were struggling with constipation and he was still no where near potty trained. I could not imagine putting him on laxatives for any extended period and decided to try and handle it with periodic doses of mineral oil and hyper- vigilance about the consistency of my son's BM's.

The mineral oil worked OK for awhile, but near his 4th birthday (still in diapers), he had another bad bout of constipation. He was so miserable and I couldn't bear to see my son in pain again. We were also anxious to have start potty training which we were unable to do because of the constipation/witholding. I knew he would withold if we took him out of diapers and the whole vicious cycle would start over again, so I agreed to try the MiraLax.

He has been on MiraLax for 4 months and I am glad to report he is now (finally!) potty trained and poops easily/happily everyday. I strongly recommend you try the MiraLax now and don't make the mistake of waiting like we did. I do believe it is safe and it has definitely helped my son. The longer you wait, the harder it is to undo the memories of painful BM's.

One other thing, our insurance Blue Shield HMO, does not have MiraLax on their Formulary so we have paid $90/month ($45 2x/month)for the prescriptions. I believe you can fight this and try to have them cover it, but we have not tried yet. Most Dr's would agree that there is no realistic alternative for MiraLax and would be willing to write a letter or call your insurance company. Just be aware, you may need to shell out a lot of $$ or be prepared to fight your insurance company on this issue.

Good Luck! I would be happy to discuss this further, so feel free to email me if you want. lslez

I posted the same question here a few months back. This is a complete issue of control. Bowel movement is the first thing a child can control in their life.

My advice to you is to give it up. He will live. Let go. He can sense your urgency in trying to control it. Keep giving the laxative. My rule is if he doesn't go for 3 days, then I give it. Usually right about the time I feel it is too long, I give it.

My son is now 3.3 years old. I can communicate with him more about it. But when he was younger..that was more difficult. My niece had the same thing. Go on the internet, this condition actually has a name.

Bottom line is that eventually he will learn that he can poop and be OK. The longst my son held it for was 8 days, and I was a wreck.

Say the serentity prayer to yourself God grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference

I am not religious but this helped me because I truly could not control his pooping. Let your child feel he contols other things. Give him choices so he feels he is deciding, even with the most mundane of things.

Relax. I was a wreck for so long with this and now that I gave it up he has relaxed about it. I feel my son is coming out of it now. So the whole thing lasted near 6 months.

It started with him when he had a difficult poop with his nanny and she told him it was stuck and she would have to pull it out. email me if you want
yancy

Has your child been examined by a good chiropractor? My husband suffered from years of constipation, alternating with diarrhea. He underwent thousands of dollars of medical tests, and they found nothing. My Mom and I dragged him to a chiropractor, even though he did not believe in them. After three visits, his bowels were regular. He now willingly goes occasionally when things act up; he feels so much better. Apparently, there was pressure on the nerves that control bowel function. He also has to stick to a high fiber diet, which is what doctors recommend for everyone. It sounds like you have that part covered. You may also want to look into other food allergies, besides milk. Tami

We are at the end of the rope with my 3 year old daughter. At some point between 1 & 2 years, she started screaming every time she went poop. She only pooped every few days. We took her to the doctor. She went on miralax and then other meds for about a year, but no changes. We went to specialist who told us to continue with miralax at a higher dose and give up on potty training for 6 months (she was trained in pee). Screaming stopped, but poop got mushy and runny and came out all the time. Over the next year, we slowly reduced the amount of miralax to none as it just made it ''leak'' out. Here is the current pattern: She starts to feel like she has to poop. She holds it in and is in some discomfort. The next day, she really tries to hold it in and is in greater discomfort. Several times a day, pellet size poops come out in her butt and she needs them wiped away. The next day (day 3), she is still holding it in, but it's almost impossible so she is in a lot of pain, screaming and crying but refusing to walk to the bathroom or even a potty if put in front of her. She won't ask for help. She won't do anything except scream.

We got a referral to child behavior at Kaiser who told us to tell her ''you are in charge of your poop'' and not to help her at all unless she asks. So we tried it and she just stands in the living room (or anywhere else like at park, play area, class, etc) when the urge comes on, screaming. If you try to carry her to the toilet, she screams more. She can articulate that she is ''in charge'' and how to use the potty and where to go and all that, but when it actually comes time to do it, she just screams. At some point on day 3, 4 or 5, if you carry her to the toilet and force her (hold her down and open her legs) to sit there, the poop comes out. Easily. So we are in a 3-5 day cycle where the only day she isn't screaming the day after her poop comes out, but on every other day, she screams and tries to hold it in.

We've tried everything. Bribes, punishment, ignoring her, helping her excessively, reading books about poop, putting her back in diapers, etc. I'll add this cycle is the same even if she is wearing diapers.

The only other thing to note is that she is a twin and her sister has been fully potty trained since 2 1/4. No poop issues.

I'm hoping to god one of you has something that might work because I am about to lose my mind.

All I can say is, been there....

I had an epiphany at one point and realized my son's screams were, not b/c the poop hurt, but b/c he was fighting so hard to keep it in!

Encopresis is not always a control issue stemming from diaper training-- it could have resulted from a painful poop and fear of it hurting again. Regardless of its start, it gets physical and can get so severe that the rectum's shape stretches out. The poop balls up and then leaks come around it, hence the smears and little hershey kisses that occur, not to mention the excruciating bowel movements!

My son is a great eater but no amount of fiber was going to fix the problem. Our pediatrician said that the Miralax allowed the rectum to shrink back to it's normal tube shape b/c the movements weren't left to gather and ball up. I found Miralax to work more efficiently and less intrusively by splitting the dosage up to 1/2 in the morning, 1/2 in the evening. He was on it for 10 months with a couple of breaks to see if it resolved. During the breaks, he was back to having trouble with a couple of days! I did not want him on Miralax forever!

Finally, I met a homeopath who felt she could resolve this issue for us. She took our case and we decided to try the remedy during an extended school break (Thanksgiving) so if he had a problem, it wouldn't happen at school (he was in kindergarten by then!).

So, on a Tuesday my son took his last dose of Miralax. On Wednesday, he received a homeopathic remedy. I didn't share with him for a few months that he wasn't taking the medicine anymore but when I did he was thrilled! He is now in the 2nd grade and hasn't had Miralax since that last time two yrs ago. He has had no issues whatsoever! One time the same year, he backed up a bit and the homeopath gave him an emergency remedy which caused him to poop within 20 minutes(!!!). Anyway, a day later, he developed a virus with a high fever and in hindsight, we believed his body was reacting to the oncoming virus and would have resolved on its own; that it wasn't a recurrence of the encopresis!

I will readily admit that I didn't put much faith into the homeopathic remedy but I am a true believer now! Even our pediatrician was amazed, thrilled and entirely supportive! LogicalMama

HI! I'm sorry I didn't respond earlier, but chances are you're still having the problem. We experienced this with our youngest, now 4. She started the problem very young, eventually was completely potty trained, even through the night, but when she did finally poop, it was in a diaper, with me wrapped around her crying as much as she was! We tried Miralax, suppositories, countless fiber drinks, excessive water, etc, you name it. We went to 5 different doctors, though not a homeopath and I'm sure they'll help. It was a matter of fear of pain, so she'd hold it in, then it would be unGodly huge. We would both be sweaty and wailing by the time it was over, and it was about on a 5 day cycle as you describe. Let me tell you what worked! L'il Tummies! WHAT?! I'm telling a friend from NY about it, she says try this over the counter stuff, L'il Tummies that not one stinkin' doctor told me about, and voila! At first, it's hard to get the dosage right. It tips the scale the other way, if you feel me. So, what we did, I highly recommend. It was easier with a diaper, but still..

Give him the highest dosage for about a week or so. Keep him pooping. It doesn't leak, as you described, but it will be a bit of diarreah.It's ok, the trick is to get it all out. Pretty soon he will be pooping without pain, though the excess of it may bother him. It's ok, getting him to poop without pain is the key. Soon you can lessen the dose. We struggled with this issue for almost 3 years. It was all over in about a month. L'il Tummies is a natural herb, Senalina I believe it's called. Perhaps the same thing the homeopath gives, but i wouldn't know! Try it, it'll be alot cheaper and I now know 3 of us that all had the same problem and it was a miracle. Last thing, my little girl still needs a little bit from time to time. She'll still say her poop hurts and i give her a small dose right away. By that night she goes, easily, and she loves her ''chocolate stuff''. Some people struggle with this all their lives, our kids will probably be those people. Better to help them accept that now and give them the power to help themselves. Right in the Walgreens aisle! And seriously, we tried everything else, too! Good luck! excited to share the secret!

Had a huge issue with this until our daughter turned about 4 1/4 years. Holding poop for fear of pain, then having a huge, scary BM every 5 days or so. Wanting pull-ups for BM's, despite being potty trained. Some leakage in between with use of Miralax.

Finally we spoke with a pedi GI doc who recommended using Magnesium Citrate - having her drink a couple bottles to clear herself out at first. She was actually excited to drink it as like 'soda' which she doesn't normally get to drink. This worked like a charm.

Then we set a regular dose of Miralax to keep her poops very soft. Spent time on the potty after every meal (at least breakfast and lunch). At first was tricky to even get her near the potty, but stressed that was just time sitting there - no need to actually 'do' anything. We made a sticker chart and each time (after each meal) that she sat on the potty, she got to put a sticker up (poop not necessary). Crazy, but this worked like a charm and she became so confident and proud of herself. She soon lost interest in the stickers and now we are just careful to keep her stool soft (though cutting back on the Miralx slightly). Extremely thankful

My 3-year old was potty trained for about a month when she started withholding her poops. We initially thought she was constipated but after 2 months of this behavior, I now know she is ''not letting it come out.'' It was really bad when she was using the potty. Now, we're back to pull-ups. She will ask for a pull-up when she has to poop. Then she makes all of the pushing and grunting sounds and sometimes cries that it hurts (after 3 days of not pooping, I'm sure her tummy does hurt), and says she is trying to poop. But I finally figured out that what she is doing is working really hard to hold it in. She started this shortly before her 3rd birthday, around the time she transitioning to a new classroom at school, a change she has been looking forward to for some time. I am trying not to make a big deal out of this. I have no problem with her using a pull-up. I've set the bathroom up so she has privacy but can entertain herself. I've offered her a reward for ''letting the poop come out.'' Nothing seems to work. I know it's a control thing and that I should just ignore it, which I am trying to do. But sometimes it makes me crazy as she will spend all day trying not to poop, will be whiny and irritable, won't want to play with anyone or go anywhere, etc. Any advice or words of wisdon or commiseration will be much appreciated!
To Poop or Not to Poop

Hi we had the same problem 3 things you need to do we went to a specialist and here is the just. Do not have any anxiety or control about the pooping in fornt of them ifthe more they feel you are anxious the worst it is. here is the solution give them one tablespoon of mineral oil 2/day everyday they will not beable to hold it it will come out oily in their underwear pull up etc.. don't worry and it is not harmful for them to be on my daughter was on it for 6 months and i still give it to her when she gets backed up it we were so anxious it was a terrible cycle so give th oil it may take a a day or two to work my daughter took it straight them took some water but you can mix it in whatever works.It is thick so you have to have something to drink right after. once it works try to not focus on it and it will get better I promise. Also the woman we saw was Megg Zwiebeck she lives in Oakland and is an expert on this stuff. I think she is on this network. Good luck
anon

Honey, I was in the exact same boat with you. Your daughter probably had a painful poop and thought, ''Well, I won't be doing that again!'' My son went through that after my doctor said not to give him juice because it was empty calories. What ended up happening was he stopped drinking all together, got constipated, had a painful poo, and then held in all following poops with all his might. It was horrible to see him pass these huge, painful poops after 3 to 4 days of holding it in. Mix in some Citricel with her juice. It worked for my son, and hopefully it will work with your child.
been there

I am so sorry you have to experience this. My son, now 4, has very similar pooping issues. About two years ago, he started becoming ''constipated,'' not pooping for three days at a time. We took him to the doctor and were assured that it was normal. Three days turned into 7 and then they took our problem more seriously. Up to two days before he actually pooped, he would be on the ground hysterically screaming ''no poo poo.'' In the three day span stage, we started with prune juice (which he hated), pear juice, whole wheat everything, and lots of fruit and veggies. The doctor suggested sprinkling bran in his food, a good source of fiber and easy to hide.

We also gave him mineral oil... and none of this helped. Finally, after 7 long months we got a referral to a gastroenterologist at Children's Hospital. Dr. Haddad is very kind and attentive. He understood the severity of how this was affecting our lives, and explained that our problem was definitely a control issue, and it would be fixed but we had to think in terms of months and years (a slow process). After our first visit, he prescribed a suppository to make him go immediately (we had been avoiding this), and then Miralax every day (a laxative that makes the stool very soft and easy to pass).

Now, my son is down to half a dose every other day and is pooping almost every day. He gets his medicine mixed w/ juice around 5, and poops at 6pm. He will only poop in a diaper, though is potty trained otherwise. It is more important for him to be going, than worry about the diaper. The dr. says ''he won't be wearing diapers to college.'' Also, letting him decide when to start pooping in the potty will give him that sense of control he fights so desperately for. I hope this helps.
in your shoes

I don't have any advice on this issue but I do have a three year old who is doing something very similar. In her case she does not want to use the bathroom when she is doing something more interesting -- which is most of the time. Because she is not using the bathroom, she gets constipated and also has small ''accidents.'' Once she is constipated, it is very hard for her to go. We are trying taking her to the bathroom at regular intervals (like after meals), which seems to help but has definitely not solved the problem.
In the same boat

Hi - Our son did exactly the same thing. He was a very late potty trainer. Its all a haze now, but I think around 3.5 he was using the potty but still pooping in the diaper. I tried many times to gently get him to use the potty. No way - he wouldn't have it. I let it go because it was a control issue and having been told he'd outgrow it. Well, he didn't. Finally at 4 yrs, 2 months old I took away the diaper. He didn't poop for a week then finally went on the potty after much crying. He had gotten to the point he was laying on the couch because if he stood up, the poop would come out. Throughout the week, I did this all nicely, offered him treats, sat on the potty with him for hours and didn't get mad. He just had to let it go. AFter he went one time, he was so ecstatic that he has never had a problem again. He was soooo ready.

My advice? Let your daughter keep the pullups and see what happens. Keep trying gently to get her to poop. But at some point, you may need to get her to go on the potty. For some reason she is 'afraid' of letting go and all you can do is talk her through it. HOpefully it won't be traumatic when she goes the first time (in the potty) and she'll see it feels much better than holding all the time. I have no idea why they choose discomfort rather than release, but some do. Good luck ~ The potty rocks

My son did that too at age 3. He would hold his poop all day until he got home and into a diaper. It got so bad that he even became impacted. When that happened, his pediatrician treated him and suggested to let him use a diaper when he requested one to prevent more impactions and possible infections. We let him have a diaper to poop. He didn't get impacted anymore and became really confident at controlling his bowels. The diapers requests didn't last long (only 2 months or so) and in the end everything worked out. Less stress for everyone. niki

My son did this from his first bite of solid food at 8 months till 3 years. we tried EVERYTHING & he still pooped big dry logs after 7 - 10 days & often bloodied his little bum, it was awful. Our wise and wonderful pediatrician, Elmer Grossman, now retired, said this: ''Ok, I think he's a little young, but try this. Go buy a family of dolls, a toy toilet, and some brown clay. Make a little turd out of the clay & initiate a game with him, with you playing the boy, him playing the mom or dad. At some point, after the game is really going strong, have the toy boy say 'Mommy I have to go poo. No I don't want to go poo'. Then watch him. If this works as it should, you may gain some insight into what is causing him to withhold.'' WELL, we got the dolls & the toilet, made the little turd out of clay, & got the game going. When I (as toy boy) said ''Mommy I need to poo. No I don't want to go poo,'' My son said, frantically, MOMMY I HAVE TO GO POO! He ran off to the bathroom & did a big one & was never constipated again. It was extraordinary. We never even got to brandish the clay turd. Whatever was in his mind about poop & pain must have been safer for him to view from the distance of play, he worked it out on the spot & has been an appreciative pooper ever since. He's 17 now. Best of luck, I know you must be frantic.
jenny

I don't remember the original post, and I haven't had to deal with this problem with my son, but I recently read a book on nutrition by a doctor at the Harvard School for Public Health. He summarized a study as follows: a group of young children with severe constiptation were taken off cow's milk and switched to soy. Within two weeks, two-thirds of the kids started pooping normally and their constipation disappeared. For kids who have constipation so bad they need medication, this might be worth a try if they drink cow's milk. (The book where I read this, BTW, is: Eat, Drink and be Healthy by Walter Willett
My two cents

I saw this posting a lot later because I was unable to check my e-mail. My son had the same problem when he was 3. I think he just didn't like how messy it was and he had trouble wiping. He just wasn't coordinated enough to wipe well. It would smear and he would miss ''spots'' He just didn't want to deal with it so when he went #2, he would finish sooner than he should've. He ended up constipated and I had to take him to the emergency room where he had to get an enema. In any case, what if you were to provide warm wipes? My brother-in-law is the same age I am and he ONLY uses wipes. I couldn't believe it, but it's true. You could put the box of wipes in a wipe warmer next to his potty... I didn't know this then, but they make flushable wipes. My husband used them to wipe seniors with Alzheimer's at a senior center he used to work at. Just a suggestion.
My Boy Wouldn't Poop Either.

our son is just shy of 3 years old. He was starting to potty train, very successfully, when he came down with the flu, and didn't have a bowel movement that whole week. This started a cycle of holding in his poop, willfully. It has now been going on for 6 weeks. At the beginning he had lots of pain so we took him to the emergency room twice where had an enema. He now goes once every couple of days, but just enough to release a little pressure. We now see that the pain is caused by his holding it in, which he does with all the willpower of a 35 year old man. It's amazing! Under the advice of our pediatrician, we are giving him mineral oil morning and night. We are also feeding him lots of juices, raisins, apricots, flax cereal, etc... We are at a loss as to how to comfort him or how to react when he says ''my tushy hurts'' and then proceeds to do whatever he can to keep himself from going (ie jumping around the room and clenching his fists!) HELP! Has anyone experienced this type of thing? The pediatrician says it's common, but hasn't given us specific tips as to how to react (or not?) to the discomfort that accompanies the holding it in. It has been totally disruptive to our lives - hoping someone has some practical tips. Thanks for listening! Carolyn

I can totally relate. My daughter, now 3 1/2, has been withholding poops since 18 months (two years now). She, too, has impressive bowel control. I often wonder what she could accomplish if she harnessed that power for something constructive!

Our ped. has advised us to give her Miralax, which we do daily, to keep the poops soft. The key is for the child to go every day, or every other day (and not the every 4-6 days as my daughter tries to get away with). If her usual dose (1/2 an adult dose) isn't working, we give her more: otherwise, the stool builds up and hardens, her rectal vault gets distended, and she will have a terrible time letting herself go. At times, we've had to give her 2 full adult doses per day. It sounds like the mineral oil is supposed to do the same thing as the Miralax. My ped. told me that it's much better to treat the problem from within than from without, like with enemas, suppositories, etc.

You had also asked about the behaviors. We have been having success for the past 3 months by following the routine below::

1. Every night, about an hour after dinner, I announce it's poop time. Sometimes she acquiesces, but most often she protests, cries, whines, etc. I don't give in, and basically make her sit on the potty. (''Do you want to walk to the potty, or should I carry you?'' is my opening gambit, but I've also just carried her in and placed her on the toilet. She hates it at first, but calms down pretty quickly and is always in SUCH a good mood after she goes that it seems to minimize the trauma of going in the first place). [I'm hoping that by following a daily routine, her body will start ''wanting'' to go at that time every day]

2. We sit in the bathroom for awhile. I remind her how good she feels when she goes, how big kids/big people go poop every day, and how she'll get a poop treat once she goes. Sometimes we read a story, but I try not to do too many things that will distract her from the matter at hand. Because I think she's forgotten how to go--or rather, she wouldn't allow herself to let go after having the normal feelings of needing to eliminate--I help her visualize how to go: relax her bottom, let her bottom make an ''O'' shape, and let the poop come out. I make up all sorts of silly stories about the poops themselves: anything to make the experience positive!

3. Sometimes all the positive stuff doesn't work, and then I threaten a Fleet Baby Enema--she's had that twice, and hates it. I know--I hate to use threats, but sometimes it's the only thing that does the trick.

4. Once she goes, I make sure her bottom is clean (using baby wipes or warm wash cloth). If her bottom isn't clean, it's apt to get red and irritated, which means the poop will hurt as it comes out next time (not from any constipation, just from passing the sensitive skin).

5. Give her her poop treat, which can be anything your child really wants. In our case, it's some candy.

6. Reiterate how proud I am of her, how she's such a big girl for going poop, how it didn't hurt, etc.

I have learned the hard way that I have to be REALLY vigilant. If we let it go for a few days, all the old withholding behaviors come back full force.

We have good weeks and bad ones. Sometimes she goes into the bathroom all by herself and, lo and behold, makes a poop without any prompting. Other times, she withholds, and then carries on as if I'm trying to torture her when I insist she try and go. This can be a very, very long process, which is discouraging (to say the least). I'm hopeful that by following a routine, we'll eventually get to the point where her body learns to go on its own, and she allows her body to function normally.

Best of luck to you guys! Christine

Our daughter went through the same struggle and refusal to poop when she was in her 3's. It lasted for months (the screaming and kicking while sitting on the toilet and the 2+ days without a BM). It does get better.

It dawned on me that she was eating a banana and a PB almost every day. Those foods can cause constipation/some tummy pain. In addition to limiting those 2 foods, I also stopped buying Pull-ups and explained to her that 'this is the last one and after that you will have to go poo-poo in the potty.' It somehow clicked for her and she started pooping in the potty. Good luck angela

My son had this problem too. He is now 10 and, while largely in control, still has some problems related to this.

He held his poop so long that it would slip out when he slept at nap time. Since he was in preschool all day, we were not aware of the problem until he started soiling his pants. His doctor also had us give him mineral oil, which actually caused him to have even more accidents! However, I think that ultimately, that was the way to go. Unfortunately, because we hadn't acted sooner, his body lost its ability to feel when he had to go, which was causing the frequent accidents.

I agree with the folks who say deal with it now and in a positive way - especially as it can lead to a problem that will persist for many years. But I would also look into why it is happening in the first place. In my son's case, I found that he had been teased a bit in the potty room at preschool, which was what led him to not want to spend much time in there.

Good luck! fm

Hello. I can relate to your delimma. I just went through this with my son. I can't remember if you are potty traing, but we gave up altogether on that and let him know that it was okay to go in his pants if he needed to.

It was not an easy process- we actually ended up having to use enemas (he would not poop for up to a week). Honestly I think some kids go through this. We tried mineral oil, we tried mild laxatives, we tried getting him to drink more liquids, we tried coaxing, we tried threats, everything under the sun. He pretty much resisted everything. After the 3rd enema, he figured out that pooping on his own was a lot easier a lot more pleasant an experience. Another thing that helped was trying to encourage him for being such a big boy, talking a LOT about how everyone poops, etc. We even resorted to bribery- if he pooped X number of times on the potty he could get Annie and Clarabel (Thomas the Tank Engine coaches).

Also now when he poops on the potty, he likes to hold a train or helicopter because he says that they ''help'' him poop. We also made a big deal when he did poop- lots of cheers, hugs, high fives, the works.

I know it is hard, but just try to staty patient and viligent, he will get it worked out. Hope it happens soon! Lisa

Hi everyone, My 3 and a half year-old daughter has been asking for diapers when she needs to go ''poupou,'' and having accidents in her pants when she is not with me. I don't mind these two behaviors. It will take the time it has to take for her to be ready. Now, here is the problem. At her school she has accidents, and sometimes she will deny it with the teachers. Then she withdraw from the other kids (she stays alone); she told me once it's because she does not want the other kids to smell her. At home, she put a piece of schotch tape on the bottom of her favorite stuffed animal; so ''the poupou can't come out,'' she says. Also sometimes even with me, she will not go pipi on the potty, and will refuse a diaper. She just hold herself until she can't hold it no more (the same with ''poupou'' if I am not with her). What disturbs me is that she is holding so much (up to 4 days for ''poupou'' during Christmas time - we were away to my parents, and I guess, she reacted to the new environment) and must feel so uncomfortable; and, now I worry about this withdrawing behavior at school. In the past, she saw all the videos and books about potty training; I promised her the best toys if she does ''poupou'' in the potty. We use a calendar that we put stickers in for pipi in potty (or poupou, if ever,...) I do not act negatively if she has accidents; rather, I try to show that I have confidence in her (''I know that, when you'll be ready to use the potty, you'll get there on time). Any suggestions? thank you

My son went through a period of time doing the same thing, especially at school. After awhile, we finally discovered that for some reason innate to him (i.e., nothing we ever specifically taught him) he really wanted his privacy, and what was bothering him about going to the potty at school was that there was no door. This is typical in preschools for safety reasons, so that the teachers can always have an eye on everyone, etc. We discussed this with a school and they installed a half door, which helped. Another issue with him was that by holding it in for awhile, it would tend to harden and make going poop, when he finally would do it, a bit painful, whcih would motivate him to hold it in even more next time, and constipation became a real problem. We tried a mild stool softener, which helped a lot. Ultimately, it's a phase that has to do with gaining control and confidence over the whole process, and it will pass. Perhaps try to find out what you can do to make it easier for her, even letting her put on a diaper, and asking the teachers at school to do this for her if she requests it. It won't go on forever, and if it allows her to relax and go when she needs to, that is the most important thing, for now.

Help! My 3 1/2 yr old daughter has been holding in her poop for about 1 year now. We have tried everything from changing her diet, to drinking prune juice, to giving her mineral oil. All has helped, but she still will not let it go naturally. We have read books about going ''poopy'' and I explain to her that it is a normal bodily function, but she just refuses to let her poop come out when she has to go. She will hold it for as long as she can, no matter what. I will let her fight it for a day or two, but then I can't stand to see her suffer so I place her on the toilet (usually kicking and screaming) until she fianlly goes. She is terrified when she see it come out of her. When she finally does go, she cheers and brags about going and asks for a treat for going, but then the next time she has to go she refuses again. Its just a constant cycle. We go through this about every 2-3 days. She just fights it as long as possible to hold it. Does anyone have any advise on how to let her know that she doesn't have to suffer every time she has the urge and that it doesn't have to hurt when you go? I appreciate any advise.

There is a pediatric gastro-intestinal group of doctors in San Francisco. Within their office they have a person who specializes in pediatric bio-feedback therapy for issues like this. Please ask your pediatrician for a referral. I know one of the doctors is Dr. Linn.
anon.

I was so glad to see your posting. My 3 year old has been 'controlling' his poop for about 3 1/2 months now. He was a great daily pooper until one day he had an especially hard poop with his nanny and she ''pulled it out'' because ''it was stuck'' and that was it. From that day on he has held it in and refused to let it go. I have been beside myself often about this. Pooping is the first thing our little ones feel they can control in their lives. My boy is so strong willed that he has hald it up to 8 days. When he does poop it is not hard or constipated. It is actually loose.

I noticed when I became more controlling over him he held it longer. Like when he turned 3 yrs I sort of tightened my discipline of him. That was when he went w/out for a week. His pediatrician prescribed Miralax, a gre! at laxitive that you can hide in any drink. But this makes it as loose as can be. After I actually 'gave it up'--stopped trying to control his poop. He has been pooping every other day now for over a week. He still fights it and he is proud afterwards. I say very little now about it. I sometimes tell him ppop likes to comeout an that it was nice that he let it go. I told him it was up to him if he wanted to poop. I try to make him feel like he controls things in his life.

Incidentally, this happened about 3 weeks prior to our move away from his dad. He may have picked up on the stress in the relationship.

My niece did this with here poop for a year or more. It is actually labeled encopresis. You can go on the internet to read about it. Type in encopresis + without holding All advice I was given is that potty training during this time is futile. This is very common. 3% of all visits to ped. involves poop issues.

Seriously, you have to let go of trying to control it. Its a big lesson for us parents. Also, I remind myself that he will poop normally someday and that, at least with my now 11 year old niece, there are no lasting effects. She doesn't even remember. good luck

Help! My 3.5 yr old boy is suffering from chronic constipation. We've consulted with two pediatricians and the only advise we're getting is a restricted diet (no dairy/apples/bananas; eat bran/whole wheat,etc.) and dosages of mineral oil (4-6 tablespoons/day). The mineral oil is coming out, but that's about all. Poops are every 7-10 days - if we're lucky. We've done two enemas about 4 weeks apart; they work in a big way to clean him out, but then nothing. I'm opposed to interventions like this, but you can really tell he's uncomfortable a good bit of the time (this has been going on for about 6 months). He's a very picky eater to begin with, and the few things he will eat are restricted. BTW, he's not toilet trained yet, and I think this problem is standing in the way. Any ideas would be greatly appreciated.

My daughter was very bothered by constipation. We went thru some very upsetting times. Mineral oil worked, but I only gave it to her went the problem developed, not on a regular basis. She didn't like suppositories, but, on a few occasions, I resorted to them. In July, when she was very uncomfortable and had not gone in over a week, I called the doctor (not the first time) to ask for some help. Milk of magnesia was suggested and she has not had a problem since. I give her a tiny bit (less than a teaspoon) every morning (or, sometimes, every other morning) and it does the trick. It is no longer a big deal to go, she goes every day, and the problem seems to be resolved. I intend to ask the doctor whether I should try to tapper off, if there is any problem with prolonged use of a laxative, etc. But, at this point, remembering how horrible the problem had become, I strongly suggest milk of magnesia. My daughter prefers the mint flavor, but I think there is a cherry flavor as well.

I have found that if our now 3 1/2 year old daughter gets constipation it relates almost entirely with lack of hydration. If you can get enough fluids into her then the constipation goes away. I am surprised that the two doctors you consulted with did not inform you of this. Best of luck.

When my youngest son was about 2 1/2 and still in diapers, he went through a painful (for all of us) period of constipation - infrequent and uncomfortable elimination. He would not go for days at a time, sometimes up to a week, and then the poor little guy would stand up, hold onto something until his knuckles were white and he was purple in the face, grunt, and sometimes succeed in his efforts and sometimes not. If he was successful, he would be sobbing; if not, we would try to comfort and encourage him, knowing that the longer he put it off, the worse it would probably be. We began examining his diet, trying to pinpoint anything new that he had been eating. We also had heard that dairy products might be contributing to the constipation, but these were not new. One thing we did cut way back on was the amount of cottage cheese (one of his favorites at the time) since this was cited as a common offender. The problem still continued, however, for several months, on and off. It wasn't until he made the full transition from our in-home shared daycare arrangement to a small preschool that the mystery was solved - our daycare provider, a warm, wonderful woman, had been sharing her lunch and snacks with him, and had been letting him eat all of the pistachio nuts that he wanted. Apparently his little teeth weren't chewing them thoroughly, and they were providing some extra (and painful) bulk to his stool. Once these were eliminated from the diet, and he was no longer holding back in fear that pooping would hurt him, all returned to normal.

I feel your pain, as well as your child's. My daughter had the same problem between 2.5 and 3 years. We tried everything you listed, none of which helped us either. What finally worked was to give her carrots at lunch and mandarin oranges at night (I still stock up at Safeway - the brand she liked best!) She too was a very picky eater, but she understood that this would help her not hurt anymore. E-mail me privately if you would like.

Have you asked him whether he considers poopy diapers yucky, as in, maybe so yucky that he doesn't want to poop into his diaper? If that's the case, maybe trying the potty for a couple minutes, once in the morning and once in the evening, might be worthwhile. maybe after a cup of prune juice and a half-hour walk.

This is nothing to fool around with. My daughter had this problem to the point where she lost all bowel control and pooped in her pants all the time (it has to come out at some point and will). I tried all kinds of diet stuff, and the doctors assured me that it was just a toilet training issue, until I finally went to the right doctor when she was 5 years old. This was after two years at least of frustration, mess, and general misery, and many arguments with parents, etc. about diet and toilet training. I myself tend to be non-interferring by nature in these matters. In any case, the doctor had an xray done which showed that her bowel was completely packed with cement-like stuff. He sent me to the store for mineral oil, a fleets enema, citroma, and milk of magnesia. This was an embarassing check out. He had her drink 8 ounces of mineral oil (you can mix it with chocolate syrup but it is gross any way you want to think about it), had me give her an enema, and then the following day take the citroma. Then a tablespoon of Milk of magnesia morning and night for months. The bowel has to be re-trained. The child has to be encouraged and reminded to use the toilet after every meal. Eventually, you taper off the milk of magnesia. Now, if she shows any sign of a problem, I give her milk of magnesia for a day or two. I also give her a lot of fruit. BUT she could not have been cured by diet, and by nature she is a girl who loves fruits and vegetatables and eats a lot of them, so this problem did not originate with diet. I have my own theories about it, but I will spare you. Personality is no small part. The doctor name for this is encopresis, and there is a wealth of information on the web under pediatric encopresis, including recommended tapering off rates. It is not a rare problem, actually.

To the parent(s) of the chronically constipated 3.5 year old, our son (not 7) experienced the same problems, at around the age of 5. After several trips to Kaiser, several bottles of mineral oil, etc., the prognosis was that the nerves in the intestine weren't wired quite correctly, so that our son's intestines' weren't notifying him that his bowels were full.

Ever since we've been giving him a prescription medicine called Propulsid which apparently inspires the intestinal nerves to send the proper signals, and the results have been good. He still experiences some constipation, but not nearly so bad as it used to be. We're hopeful that after a period of time, we'll be able to abandon the propulsid.

I should probably also add that our son has some diabilities which, for lack of a consistant pattern and diagnosis, are generally classified as developmental delay. Not sure how that might tie in with the intestinal nerve thing, but I thought I'd mention it.

I understand your concern. When my son, who is now three and half and basically toilet trained, was beginning to use the toilet he would refuse to poop. He held it for as long as could, three days usually and then would have an accident. He actually seemed scared to sit on the toilet. The constipation problem actaully started when he was still wearing diapers, but beginning to sense the control he had over his pee and poop. We saw what it meant to be literally anal retentive, and we felt so bad for him. Like your son, he was uncomfortable so much of the time. Eventually, someone recommended having him sit on the potty at the same time everyday for between ten minutes to a half an hour. Maybe after dinner or in the afternoons when it was convenient for the family. It was to help regulate him and to help him get used to the potty. We didn't read to him or otherwise distract him. We simply stayed with him and tried to let him concentrate on the activity at hand. Eventually, after many, many trials he was able to relax.

I would say we have been working on this for six months. Though he still resists a couple times a week and he rarely poops anywhere but our house, he has come to be able to poop almost everyday. Another suggestion is reading books about toilet training and poop in general - we found our son was squeamish about poop and this helped to ease his unease.

I know it is different since your son is still in diapers, but maybe he is beginning to become ready to use the toilet and is worried about making mistakes. The most important thing is to reassure him and not become overly tense and obsessed about his poops. I know this is difficult, but he can be affected by your anxiety. Good luck!

Our daughter, age 4, was just diagnosed with Encopresis - chronic constipation. Her prognosis - it takes as long to fix the problem as it did to get the problem. We are giving her Kodremul (a laxative) every evening, and helping her remember to sit on the toilet every day at the same time. With the laxative, she has successfully had a bowel movement every day for weeks. She has always had constipation issues although she was very easy to potty train (I remember when she was 9 months old, trying so hard not to poop.) For her, I think it is a strong-willed, controlling child issue. (They do say that it is phychological, not physiological). In any case, I found lots of info on the web, although I'm still looking for info regarding how encopresis affects behavior. Would love to hear from other parents of kids with this problem and any behavior stuff they went through.

We have been seeing a pediatric social worker, Meg Zweiback, for three months following a visit to the emergency room with our 4.5 year old son---who had unbeknownst to us been holding onto his bowel movements. It is an extremely long story. I would suggest in the strongest terms though that you discuss this with your pediatrician and work on solving in; there can be some physical complications of 'holding' that can take quite a while to undo. If you can afford Meg, consider calling her. She is a wise, practical, supportive, and experienced. She is $90/hr (we do not see her often, and we will not see her for a long duration---just until the problem is solved). Her phone number is 836-1450. Good luck, however you handle it.

2001

A while back, someone wrote asking for advice about their child withholding poops. The American Academy of Pediatrics has good information on 'functional constipation' that I thought might be useful to the parent who was looking for insights. http://www.naspgn.org/constipation.pdf Ann

A few weeks ago, there was a thread of discussion on encopresis and constipation. Somebody wrote that she'd found Juice Plus Fiber online and was going to try it out. I also tried it out, and it has solved my 3-year-old's constipation problem! It's pretty expensive (about $36 for a case of 27 juice boxes), but it worked! My son has nice soft poo-poos now that he can't hold in. (He doesn't like the juice boxes because the boxes aren't the same color he's used to, but we poke a hole in the box and surruptitiously squeeze the fiber juice into a sippy cup with regular cider or apple juice.) The juice isn't thick or pulpy -- it looks and tastes like regular apple juice. They also have orange and grape juice, but I haven't tried those. Here's the website, in case anyone's interested: http://www.earth-friendly.com/juiceplus.php3. Thanks so much to the person who wrote about it in the first place! Hannah

My soon to be 4 year old son has been diagnosed with encopresis (withholding of his bowel movements.) I've read the postings on the website and found them helpful and would like to hear from parents who have successfully treated their child for this problem. We have consulted with our pediatrician and a pediatric nurse about the condition. Currently we are giving our son as much fiber and fluids as he will eat (he's a somewhat fussy eater, but likes some fruits, veggies, oatmeal etc.) In addition, we spike his nightly bottle of milk and water with a little Milk of Magnesia. We have our good days and bad days, but it's hard to see a general curve of improvement. Our pediatrician doesn't want us to pursue toilet training and our son is also resistant to the notion. I'm getting a little anxious about getting him potty trained since I think the delay might cause some social problems with his peers, but we don't make an issue out of it. I should add that this situation has been going on for more than a year. I would appreciate hearing from other parents the answers to the following questions: How long did it take to fix the problem? What did you do? How old was child at the time? How did potty training go? Thanks in advance.

My son developed the same condition at about this age and it took a long time to get past it. He wouldn't eat enough fiber, so the whole condition got worse. It was really difficult for the family and him. Some days he would miss school.

He wouldn't eat fruit, so we gave him apricot juice. We also had to give him mineral oil (two tablespoons mixed with frozen concentrated Hawaiian juices). The oil helps to make the bowel movements less painful.

Now he's a lot better. But if I forget to push those apples on him, he's clogged again.

Help! My son had a bout of diarrhea and it seems to have freaked him out. For the last 3 wks he has been back to normal physically, but he is terrified to have a bowel movment. He starts to cry when he knows he needs to go, telling us it will hurt, it will hurt. He works himself up to quite a state, and refuses to go alone to the bathroom. Often we sit with him for an hour while he tries to go, with him crying and worrying the whole time. While the diarrhea started this, I think, it is clearly just psychological now. His poop is normal, and we have tried everything dietwise to make it soft and easy to go. When he does finally go, he says it didn't hurt, but that doesn't seem to make the next time any easier. Now it seems he is starting to withold because of his fear...when he does go, he goes quite a lot. But he is still going every day or so. We are at our wits end, and trying very hard to be patient, but sitting in the bathroom for an hour is no fun! Also, this is a kid who has never had any problems with this kind of thing before...usually he's great about toiletting and its no big deal. Any suggestions much appreciated...we are running out of reassurances to give him and ideas. Ann

You have my sympathy! We went through this on and off (mostly on, unfortunately) from ages 3-5 starting with a bad case of constipation. Our doctor recommended powerful laxatives which we tried but eventually decided was a bad idea. What finally seemed to do the trick was offering a prize for every poop, with a ''big prize'' after 3 poops (then 4, then 5,...). Prizes were things like stickers, plastic frogs, whatever sort of one-dollar party favor type thing. The ultimate big prize was a computer game. We were amazed how this finally worked after years of the sort of struggle you described. Then again, she was a bit older by this time (almost 5), so maybe she was otherwise just ''ready''. Good luck! Karen

Help! My son had a bout of diarrhea and it seems to have freaked him out. For the last 3 wks he has been back to normal physically, but he is terrified to have a bowel movment. He starts to cry when he knows he needs to go, telling us it will hurt, it will hurt. He works himself up to quite a state, and refuses to go alone to the bathroom. Often we sit with him for an hour while he tries to go, with him crying and worrying the whole time. While the diarrhea started this, I think, it is clearly just psychological now. His poop is normal, and we have tried everything dietwise to make it soft and easy to go. When he does finally go, he says it didn't hurt, but that doesn't seem to make the next time any easier. Now it seems he is starting to withold because of his fear...when he does go, he goes quite a lot. But he is still going every day or so. We are at our wits end, and trying very hard to be patient, but sitting in the bathroom for an hour is no fun! Also, this is a kid who has never had any problems with this kind of thing before...usually he's great about toiletting and its no big deal. Any suggestions much appreciated...we are running out of reassurances to give him and ideas. Ann

You have my sympathy! We went through this on and off (mostly on, unfortunately) from ages 3-5 starting with a bad case of constipation. Our doctor recommended powerful laxatives which we tried but eventually decided was a bad idea. What finally seemed to do the trick was offering a prize for every poop, with a ''big prize'' after 3 poops (then 4, then 5,...). Prizes were things like stickers, plastic frogs, whatever sort of one-dollar party favor type thing. The ultimate big prize was a computer game. We were amazed how this finally worked after years of the sort of struggle you described. Then again, she was a bit older by this time (almost 5), so maybe she was otherwise just ''ready''. Good luck! Karen

My son, who is 5 and 1/2 years old has been having problems going to the bathroom when he needs to have a bowel movement. His doctor told me that he has a mild case of encopresis, and that it should be treated right away or it could become very serious later. She ruled out the possibility of being physiological, she thinks he needs to see a psychologist for that. What happens to him is that, when he is out of home, or playing with a friend, he doesn't stop to go to the bathroom, if he needs to poop, he tries to hold and most times gets his underwear dirty. When he is at home by himself he usually goes to the bathroom normally. This used to happen from time to time before, but in the last six months it is happening almost every day. I would like to know if anyone have had a similar experience and what they did. Also, if anyone could recommend a good children's psychiatrist that preferably would take Health Net. Thanks a lot.

I have no personal experience with this problem, but a few years ago I read a very convincing study about an experiment that helped kids with the problem. The experiment showed that group cognitive behavioral therapy and biofeedback was highly effective at helping kids with the problem. The group aspect helped the child feel less embarassed, the cognitive therapy helped them understand and adjust their thoughts and feelings about it, as well as teaching them about eating high-fiber foods, and the biofeedback helped them to re-learn how to poop normally. The kids in the study had encopresis combined with constipation, and had basically lost touch with their own body's coordination of how to poop. These kids, who were described as typical of encopretic kids, ended up with a habit of pushing the poop to get it out, but at the same time squeezing their anus closed, so that the poop couldn't get out. So they would just hold it, and it would eventually come out on its own as soiling their pants when they couldn't hold it anymore. The biofeedback helped them re-learn what the feeling of opening the anus felt like, so they could push effectively at the right time, e.g. on the toilet. It is definitely something to address right away, so that the uncoordinated habit doesn't get entrenched, and to avoid the development of painful conditions like anal fissures and hemorhoids and otherwise painful poops. Best wishes.

Feb 2000

I originally posed the constipation problem to the digest over a year ago - and, as usual, you guys came up with great advice! Since the issue has come up again, I thought I'd share what worked for us. At the time, my son was 5 and had been having problems pooping for over 2 years. For the past year, we have made real progress - though it's still a big part of our daily routine. Here's what we did...

An x-ray showed a big bag of poop. His muscles were stretched all out of shape, even after months of mineral oil and Lactulose (prescription). Our doctor recommended clean out either with daily enemas for 4-5 days or surgical removal. Why she hadn't recommended that 18 months earlier, I don't know - but I digress. We opted for the lesser trauma of the enemas. Our little guy was a real trooper.

Now we're on a daily dose of mineral oil and Milk of Magnesia. Yes, both. Some hints...

1. Mineral oil hides really well in milk shakes.

2. The emulsified mineral oil, Kondremul, is best served cold. Mix in a little chocolate syrup or strawberry syrup for flavoring. You don't need much to get results.

3. Walgreen's sells a *concentrated* Milk of Magnesia that's strawberry creme flavored. You only need to give half as much as the regular - a real plus when you're having to coax the stuff in. We serve ours cold mixed with regular milk.

Since our little guy was a pre-schooler, we were able to reason with him and explain the consequences. If you don't drink your milk and oil, your poop will get clogged and you'll need a squirt (enema). Well, no arguments there. In fact, he reminds us if he doesn't get his milk and oil for the day!

Finally, the absolute best thing we did was a consultation with Meg Zweibec. Our pediatrician had been helpful, but, by this point, I felt we really needed a coach. Our little guy was in quite a bit of discomfort, and it was impacting other parts of his life (i.e., socially, potty-training, self-esteem, etc.). Meg was great - she gave us the confidence that we could solve this one and we walked away with an action plan on how to do it. Meg's hourly rate isn't cheap - but she's worth every penny. Her number is in the Oakland white pages.

Bottom line - don't let the problem go unsolved. Exercise, increased fluid intake (good luck with that one!) and improved diet (well... you can try..) might solve the occasional bout, but if this is a persistent problem, you need extra help. Avoid prune juice - it can cause cramps (per Meg, our pediatrician and the surgeon we consulted). So does Senekot (over-the-counter). Try everything and anything til you find what works. But, whatever you do, get it resolved as soon as the symptoms develop. Good luck!

My 5&1/2 yr old daughter will only poop while sleeping. It all started 3 yrs ago, when she accidently pooped in the tub 2 nights in a row. She was sharing the tub with her sister, and the hysteria that insued caused her so much trauma, she started holding her poop in. Needless to say, constipation problems began (14 days without pooping the all time record), which also made pooping traumatic. We now have the constipation problems somewhat under control via encouraging liquids, and adding a little aloe vera juice to a night time drink (works great - doesn't block absorbtion of nutrients the way mineral oil does and doesn't cause stomach cramping). My daughter really wants to stop wearing pull-ups, but the mess with a pooped bed in the am is unbearable, and she will not wake up. She tearfully told me that she doesn't know how to poop during the day, and cannot feel when it wants to come out. Could she have permanent damage from years of constipation? Any ideas?

Sometimes the pattern you describe occurs when a child is constipated. If a child tends to hold in a lot of bm she can have a feeling of fullness in her abdomen that makes it hard for him to feel the pressure in her bladder (If she's really constipated, she might even have lessened bladder capacity, so she'd have to go more often to stay dry). To check this out, you can monitor her bowel movements for about a week. Assuming she eats a pretty normal diet, she should have a bm every day, and it should come out soft, not hard (if it plops into the toilet it's on the hard side). If you think that she's constipated, make an appointment with her health care provider for an evaluation--a two year history of withholding and constipation probably won't just get better without help (don't just get telephone advice--that's fine for a temporary problem, but not for one that has gone on this long).

Two possible strategies that I've thought of follows. For both, a really important thing is to see this as a lesson in building confidence in one's body, and trusting nature to work things out (with a little help here). Even though you sound really worried about this (and who wouldn't be?) it is also important to ACT confident that things will work out. Your child will pick up on this. And remember, to poop is normal, nothing disgusting here. COngratulations are in order even when she poops still in her pull-ups. THings willwork out, it just takes some time. (of course, this is true as long as you know this is not a medical condition.)

Strategy one. Figure out when your daughter is having her bowel movement. BEfore or after midnight? And then narrow it down. Don't wake her up, just see if you can do some detective work (nose). She probably does it at about the same time each night. If you can, then try to catch her in the act and talk softly to her (good job, feel your body pushing it out...)..still don't really wake her up, you don't want her to do her automatic response of shutting things down. Eventually, wake her up a little, not much, so she can start to feel what her body is doing. (I'm assuming that you have explained the strategy to her already...see it as a training period to get reaquainted with her body). Eventually when she can poop in her bed while awake (half asleep is good), then it's time to move a potty chair into her room, and see if she can, half-asleep, sit there (even still with her pull-ups on) and poop. etc.. eventually, you'll have a sleepy girl going to bathroom, pooping in the toilet, in the middle of the night. From there, it can be translated to recognizing the feelings during the day. This approach takes a lot of night time work though, and who can afford to lose more sleep?

Strategy two. Again in the atmosphere of a training program (like athletes have), your daughter will start a training program to retrain her body and her mind to recognize her body's signals. It can be a special project. Nothing to worry about or get overly focused on trying to poop right away. Her body's signals are still there, but may not be very loud any more and your daughter has tuned them out. SO, if she tends to have her bowel movement early at night, try an after dinner session, otherwise, maybe go for the mornings...but that's complicated by school. What this involves is stimulants to encourage the bowels to move even when she is awake. So what do you do after dinner? Exercise is a natural stimulant...start jogging with her a few blocks. DOn't expect miracles right away. But plan on a regular schedule after dinner, and then see how it goes. CHocolate, coke (caffeine) can also be used to stimulate the bowels...though different people have different sensitivites to them. SOunds like you'd rather avoid the caffeine route--so do what you're comfortable with. I'd suggest having your daughter wear pull-ups while running etc. you want her to focus on the feelings (or not focus, just start to recognize them) and not have to worry about finding the nearest bathroom. She may hate wearing them, but hopefully you can convince her that they are simply a tool to help her get in touch with certain feelings again.

ANother idea, you may want to revisit the bathtub scene--and just talk about how her sister was going through a stage where she thought pooping was disgusting. ONe's body knows when it's time to poop, and it just so happened that it happened in the bathtub. It shouldn't be any big deal. Your body is amazing-- poop is really quite a good thing. Sure, it carries germs etc., so it needs to be cleaned up, but ....you get the idea.

Good luck. I spent some years constipated as a teenager (only vague memories of it now) so your message got me thinking. There are books too about special exercises one can do to motivate the bowels (I remember laying on my back with my legs stuck up high in the air). YOur daughter might enjoy reading the potty- training or poop oriented books for toddlers (the stage my daughter is now going through). Remind her she has no problem recognizing her urination urge, so it's just a matter of time before she and her body can communicate about the bowel movement urge. Sorry for the length of this message!

My son had a similar problem, only it was slipping out during the day during rest time at school! Our pediatrician had us giving him mineral oil at night so that in the morning he would poop it all out. The thought was to help him become more regular -- fixed time every day in the comfort of his home. I don't know how much that really helped -- he still had accidents. Another frustrating thing was that he would get it under control for several weeks, then start having the accidents all over again. I can only say that he did get it together and now is just fine. He was doing it at 5 as well, so I don't think your daughter is all that unusual in this. Maybe if you can get her to sit and relax every evening before bed and read to her while she's on the toilet? Good luck! I think she'll be fine, but I know it is frustrating and disheartening!

A while back, in a similar (but different) thread, someone suggested that drinking a glass of warm water seemed to loosen the bowels, and that they would 'go' within a 1/2 hour. Haven't tried it myself, but perhaps you could get your daughter to drink a glass of water when she wakes up in the morning. Good luck.

We just asked our pediatrician about the fact that our 6 year old daughter has occasionally been pooping (a small amount, not a full bowel movement) in her underpants without realizing that she's doing so. (She also has a lot of stomach aches.) He asked some questions about her habits (one big, large-diameter poop each day), and determined that she has ''encopresis'' -- chronic constipation, with poop leaking around whatever's stuck in her intestines. He advised that we give her strong laxatives for three days to ''clean her out,'' and then a course of mild laxatives for 6 months. This all seems counterintuitive in light of what seems to be her easy regularity, but the internet completely backs him up, both on diagnosis and on treatment.

My question is: Has anyone else experienced this problem and been given similar advice, and yet achieved good results WITHOUT doing the three-day ''clean out''? It sounds so horrible, and one would think that a full six months of mild laxatives, resulting in more frequent bowel movements, would do the trick! Of course we will take our final orders from our doctor, after asking him more questions, but I'm just curious what other people's experience with this condition has been (including, for that matter, whether the three-day ''clean out'' really WAS that unpleasant, if you did it).

Thanks! Anonymous

My daughter has gone through the exact same thing and I think for your daughter's sake, you must go through the ''clean out.'' Just plan for it over the weekend. You don't mention whether or your not your doctor explained that part of the reason for the cleanout is to empty her bowels completely. Just because she's pooping every day doesn't mean she's not constipated. The reason why she's having ''leaks'' is because she needs her poops to be of ginormous size in order to feel the warning signs. When the tiny poops come, she has no idea. So her bowels are so stretched she can't have a normal size poop without an accident. You will have to clean her out and effectively, re-potty train her to poop. The good news for you is she does sound ''regular'' I assume this means at the same time too? That will work in your favor. The not so good news is you should cut back on the laxitive (Myralax, no?) but give it to her everyday for about six months.... Good luck. Been there, done that!

Hi everyone- I have a 6 yr old son who was diagnosed with encopresis and still isn't potty trined with the bm's. He will only sit on the toilet, with a fight, in Pull-ups only. That took a year to do. We are seeing a Pediatric Gastro here in Sacramento and she took an xray and said he was backed up. We are going to do Magnesium Citrate over the weekend 3X, which he gags on and I haven't been successful. After that he does his Mirilax and ex-lax.

My question is- Has anoyone had their child end up going to the hospital and getting cleaned out with the NG tube? I'm so scared and she said if this weekend doesn't work we'll have to do it.

He has a deathly fear of the potty and I cried my way into his Ped's office and said he HAS to get over the fear before wwe can do this! I dont want to clean him out and then we're back at square one. She said our ins. won't cover a psychologist but I don't know what to do. Aren't they expensive?

I'm so scared for him becuae I think this is hurting him emotionally too. We have 4 other children and it's hard to devote 100% of this to him. Any advice or suggestions of doc's would be great. We have an HMO but I've fought to get referred somewhere with our other son. Thank you so much, Marisa

We did not go through any medical intervention for my child's constipation. But I saw that we were approaching severe issues and needed to do something. We have had great success since age 3 with using Metamucil cookies on a regular basis - 1 cookie every other day seemed to work well. My child quickly understood the correlation and would ask for Metamucil if I forgot. At about age 7, we switched to FiberChoice fiber pills at 1 per day - easier and quicker to chew up. If we skip and constipation is a problem, we use regular Metamucil in diluted orange juice. Our pediatrician did not suggest any of these initially, but once we tried it and no longer have constipation problems, she says this approach seems fine. a mom

Yes, my child went into the hospital to have an NG tube placed so that she could be cleaned out. She needed to have a colonoscopy. Luckily for us she was only 8 months old at the time and thus, did not have any hospital (or pooping) anxiety. It was not a pleasant experience to say the least. Getting the tube up her nose was horrible. Maybe you could tell your son what might be in store for him if he is not able to take the Miralax himself. I suppose that's not the gentlest approach, but one way or another he's going to get cleaned out, right? I hope others are able to offer you better information on the psychological aspects of your dilemma... anon

Today, while cleaning out my children's closet I came across 5 (!) lightly to moderately soiled old undies stuffed in the back of the closet. This is not the first time I have found undies hidden like this, just not so many at one time.

I knew they belonged to my 7 year old son. I talked to him about it, letting him know that it is okay to tell me he's soiled his underwear and that I would not get mad at him. Everyone has accidents. I let him know that when he hides his soiled undies (they could have been there for weeks) it might make his room smell, I might not be able to get all the poo out of them, I have to throw some of them away(the ones beyond hope), undies cost money etc. so please allow me to wash them right away. He said he understood and ran off to play.

Then it occurred to me what the real reason is behind the hidden underwear! I remembered that for 3 years of pre-school my son NEVER, EVER would have a bowel movement during school. He always waited to come home. I always thought that he would out grow this obsession(of not pooping at school). I think he's having accidents holding in his poo at school and soiling his undies in the process.

The thought of this is breaking my heart! He needs to, but won't poo at school, has icky undies and is self conscious about the smell, uncomfortable etc. then hides the undies when he gets home. My son is a VERY well liked, and popular child at school. He gets along well with everybody, and is an excellant student.

I gently told my son that it is perfectly fine to go poo at school, and that it is not good for his body to hold it for so long.

I wonder if this had anything to do with his perfectionist personality? Is it a control issue? We are pretty layed back parents (except when it comes to social graces and table manners), and our son is a really good, well mannered, intelligent boy.

Has anyone encountered this problem before? What did you do to solve it with your child? How can I encourage and help my child understand that it's natural to go poo (even at school)? Worried mom

This is a common issue. Many children don't like school bathrooms because they are dirty and not private. Talk with his school or with your pediatrician and get permission for him to use the teacher's bathroom. He might then feel comfortable to go at school Local Pediatrician

I think I would talk to your pediatrician about this issue. It may be encopresis and benefit from medical intervention. It seems to me that your child could be ''trained'' to have a BM at home most mornings, as many people do, but there may be more to what's going on than what seems obvious and may not be, at this point, entirely within his control. pediatrician mama

My son had this same problem, and his doctor suggested he might actually be constipated, though it didn't seem like it to us. When hard poops block the way, the only thing that gets by is a trickle that is impossible to stop, leading to that soiling. His doctor suggested he take mineral oil at night for a few days in a row to help him poop in the morning. When he did, the problem (that had lasted many years and that we had thought was psychological) miraculously went away, and has not returned in several years. Ask your child's doctor, to be safe, but simply taking the mineral oil for a few days sure worked for our son. Might want to try it on a Friday night relieved mom

I think that you are handling this very well. My son is like yours and I remember in kindergarden he refused to pee or poo at school and would almost explode on a tree on the way to the car. We had a portable potty ready, lined with plastic grocery bags 3 layered so I could toss it and clean up with a wipe instead of how you would dispose of it at home. Interestingly, he was not alone in this. Several of the boys at school were holding it all day. I am laid back like you. Maybe more so! I let him wear diapers until he stopped on his own. He was changing them himself at age 4 and talking about it...''I don't want to poo in the toilet. I want to poo in a diaper.'' So, by 2nd grade, he was peeing in the boys room. He doesn't poo at school though and he has a fast system; poos shortly after every meal....except lunch on school days! I don't know if this is a problem. I am approaching it as something that will pass. Some people, when I told them about him lining up things as a toddler (just one quirk) responded by saying ''They have drugs for that.'' Which alarmed and hurt my feelings. OK, he is a control freak. Is that a clinical problem? No. Not really the subject, but I feel compelled to note here that my second son stopped wearing diapers at age 2, wants to use every public restroom everywhere....very different! I really feel for you because your boy felt he had to hide it. My boy also was ashamed of bodily functions etc. Maybe I just haven't found the stash yet! I decided to weigh in on this for you so that you would know that lots and lots of kids are like yours Really, what is normal anyway?

Hi-Our six-year-old son went through the same exact thing. He refused to go poop at school. His underwear were often smeared and soiled. He had several accidents (that I know of) in which he'd have a small ''ball'' of poop come out. He said he couldn't feel it until it happened. As it turned out, he was right. We finally took him to his pediatrician and she said he has a very common condition, usually caused by constipation (or too much milk making his bowel movements very hard.) These hard balls would build up inside, stretching out his bowel muscle to the point that he really couldn't feel he had to go until it was too late. She prescribed him a gentle stool softener, which should sort things out in about six weeks. This had been causing him a lot of embarrassment (despite our reassurances), so he was very relieved to have his doctor reaffirm that it was not his fault anon

My son just turned eight and is having problems with encopresis. He has had this problem in the past, we saw a counselor and things seemed to have gotten better. However, the problem has started back up again.

I am at a loss as to what to do. I have looked online and the resources I've found have stated that this problem is often a result of constipation, that I need to give him laxitives and get him back on a regular bowel-movement schedule, yet, I just don't know where to start.

Because he is so ashamed of the situation he often tries to hide the situation which makes things worse. He very often has accidents in his pants which I can smell it, and sometimes falls from his underwear onto our floors. It really is unsanitary, and quite awful. Though I don't let him know this, I am disgusted at the uncleanliness that he lets happen, and his resistance to clean himself up after these accidents. Again, I just don't know where to start, or what to do. Any help or advice would be so appreciated.

I've had the same problem with my son off and on since he was about 5, long after he had been successfully toilet trained. he's nine and still occasionally has problems. I'm afraid I've not been as non-judgmental as you sound. he knows that we find this unacceptable, but he's basically in denial about it.

When he starts having the problem again we point it out to him (he doesn't want to talk about it!) We try to get him to drink more water, eat applesauce and other natural methods of reducing his constipation, and when desperate we use mineral oil (he does tend toward constipation also). We also make an effort to get him to use the toilet before school, when he gets home, and before bed. The bathrooms at school are not nice and clean like at home, so he holds his bm's in at school... this leads to a bad habit of holding it. Also, he really hates stopping playing to use the toilet, that's why we've tried to get him to sit at regular times. Although it actually hasn't become a habit.

It's less frequent now... I don't know if it's because he's older and more in control of himself or not. he's definitely not a good wiper, and I often wash his soiled under separately in bleach after soaking it. I make sure that we have flushable moist wipes in the bathroom to help him clean himself better. The doctor we saw when he was 5 suggested getting him to blow up balloons while trying to make a bm: this uses the same muscles as pooping and was fun besides.

Best of luck. It's gross and you'd think he'd be too old for it, but that's the way it is. Lynn

My 6 year old daughter has had the same problem for a quite a while. I took her to a pediatric gastro-type doctor last spring and he prescribed absolutely soft stools with the help of Milk of Magnesia (non-habit forming, non-stimulant) - 1-2 tablespoons a day. The problem went away, but Ihave not yet weaned her off of the Milk of Magnesia. We saw the same doctor a week ago and he recommended a new product called Juice Plus Fiber. It is a relatively new product that comes in apple, grape and orange juice and has 10 grams of fiber in 1 8 oz carton. He claims that it does not have the type of fiber that gels into those disgusting little balls like Metamucil does. I just ordered a trial pack of 8 so can't say if this will work. They are not in the stores and are not cheap but I figured it was worth a try. You can order them at http://www.earth-friendly.com. Carol

I went to ivillage just to figure out what encopresis is, and thought the explanation and advice given there by a doctor was helpful. The link is http://www.parentsplace.com/expert/pediatrician/general/qa/0,3459,1249,00.html. You may be beyond his discussion, on the other hand, it seemed to address many of the points that are troubling you. Good luck. Kim

You need to revisit a doctor or counselor with experience with this problem. I had a child with this problem and it can become really complex psychologically for all of you. Make sure organic problems are ruled out and follow the recommendations of an expert third party. Laxative may be needed, OR some change in the way the problem in handled by the family, OR something else. We saw Dr. Durant at Kaiser Oakland. It took forever to get an appointment but he was terrific. He was able to differentiate between three possibilities:
1. an organic problem,
2. a problem that is out of the child's control,
3. a problem that is within the child's control.

Each requires a different strategy, and I don't think that the parents can figure it out for themselves, because of all the issues you mention. My daughter is still rather peeved at Dr. Durant but he is my hero. Good luck!

My 9-year-old daughter continues to struggle with encopresis and night-time bedwetting (actually, she is still in pull-ups at night and always has been). She has taken Miralax for years for encopresis, and has done the ''sitting'' thing and all the other recommended stuff, yet the problem persists. Has anyone had success with alternative medicine (e.g., homeopathy, accupuncture, whatnot?) Any suggestions would be welcome! Discouraged mom

My daughter struggled with encopresis, ages 3-5.5, with little help from pediatrician. I eventually followed advice from a med. school URL. I dosed daily on Ex-Lax chocolated laxative (senna) at the level that the urge to go exceeded her will to hold it. At first, she still had lots of poopy accidents, but at least no more 3-in.-diameter poops.

I also did heavy incentives for her to poop daily. She loved Barbie, so I gave a Barbie outfit for each poop, anywhere. Excessive maybe, but stickers did not motivate, and no time to gamble her health to find the min. that would incent her to poop. After 6 months, I lowered the dose. She had every Barbie outfit made, and we went to check-marks on the calendar. She was relieved that it got easy to poop in the right place, and to hold it until she was at the right place. Then I gradually backed the laxative down to zero. Now, at 8.5, she knows she must poop every day, part of her bed-time routine (so she can put it off as long as possible). I do not let her to skip more than 1 night without giving a dose of laxative. She now only has occasional skid marks in her undies. BTW, I got resistance from all - daughter, husband, pediatrician, friends - about my program, but felt it was my duty to do *something* beyond the nothing that they proposed. It worked, thankfully.

On Good-Nights (pull-ups): my daughter wears and needs one every night (actually she needs but eschews them daytime too). I say G-d bless Kimberly-Clark! Imagine this problem without their fantastic product!! With these, she can sleep-over and camp-out. No success story on this problem, nor advice, other than: you are not alone.

I was wondering if you have had your child evaluated for sleep apenea? It is a hidden underlying cause for bedwetting in a large majority of children. Our child was a bedwetter until nearly 5 years old when some sleuthing discovered this link. He had his toncils and adenoids removed for obstructive sleep apenia at 5 years and never wet the bed again.(well maybe once after the surgery). Dr. Wesman at Children's Hospital is informed about topic and did the surgery for us. There is not a lot of literature about it. Maybe you can check Stanford Sleep centers or the ENT Dr. Wesman. Maybe worth checking out? mom of a past bedwetter

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